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Kicking the Caffeine Habit

How dangerous is caffeineaddiction? Easily the most widely used recreational drug in the world, caffeine is regularly consumed by 85% of all adults and children in the United States according to one recent study and that figure is likely the same in most other countries. Average daily caffeine intake is estimated to be about 280 milligrams a day, the equivalent of two cups of coffee or seven 12-ounce cans of caffeinated soft drinks.

Usually considered harmless in low doses, caffeine can lead to serious health problems as well as complications in pregnancy. Caffeine intake greater than 400 milligrams can cause symptoms such as “jitters”, increased heartbeat, nausea, anxiety, dizziness and even heart failure in cardiac cases. The symptoms can be even more severe in people with a caffeine allergy. While cases of caffeine overdose are relatively rare, there have been documented cases in countries around the world. Like any other drug, regular caffeine use can also lead to physical dependence which makes it hard to quit, even for health reasons.

There are currently four caffeine-related disorders listed in the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) which include caffeine intoxication, caffeine-induced anxiety disorder, caffeine-induced sleep disorder and caffeine-related disorder not otherwise specified. A fifth condition, caffeine-withdrawal disorder, is also being considered for the latest version of the DSM due to be released this year. While caffeine dependence is not listed as a disorder in the DSM-IV-TR, it is included in the International Statistical Classification of Diseases and Mental Health Problems – 10 (ICD 10) and new research has suggested that caffeine can be considered addictive in cases where major health risks are involved.

While recognizing the addictive potential for caffeine, there has been little research looking at treating people with caffeine dependence or the kind of problems they face. A new study published in Psychopharmacology examines caffeine dependence more carefully and some of the common features found in problem coffee drinkers. Published by Laura Juliano, an associate professor at Washington, D.C.’s American University and her colleagues, the study involved telephone and face-to-face interviews with 275 participants (55.3 % women, 44.7% men) who were recruited through advertisements and who described themselves “psychologically or physically dependent on caffeine” or “have tried unsuccessfully to quit using caffeinated products in the past.” People with a history of substance use or mental health issues were excluded from the study.

Of the 94 participants who came to the clinic for further testing, the average amount of caffeine they consumed daily was 547.8 milligrams. Describing their daily caffeine intake, 74% of them reporting drinking soft drinks, 56% drinking roasted or ground coffee, 36% consuming cocoa/chocolate, and34% bag or leaf tea. They also reported caffeine from instant coffee or tea and medications containing caffeine, Both coffee and soft drinks were the most common source of caffeine and more than 81% reported having their first caffeine product within an hour of waking up in the morning (30% within the first 15 minutes). The average age when they first started drinking coffee was 15.9 years.

In terms of caffeine dependence, 96% of the participants reported experiencing caffeine withdrawal while 67% said that they experienced psychological problems due to caffeine use. That could include anxiety, irritability or even paranoia in extreme cases. Physical problems such as insomnia, stomach problems, rapid heartbeat and frequent urination were also reported by many participants. Caffeine tolerance was also a problem for many participants with over 65% needing to take in more caffeine to have the same effect. Overall, At least 93% of participants met at least three of the seven DSM-IV-TR criteria for substance dependence with symptoms such as tolerance, withdrawal, and inability to quit.

Over 88% of the participants reported at least one serious attempt to quit or cut down on caffeine (2.7 attempts was the norm) though 62% were unable to go without caffeine for more than a month. Of the 43% who had been advised by their doctor to quit or cut down on caffeine, medical reasons included heart problems, pregnancy, anxiety, insomnia, urinary problems or stomach complaints. Although 42% of the participants with caffeine dependence had a lifetime history of mood disorders there was no real difference between men and women in terms of actual caffeine use.

Surprisingly, many of the participants who appeared to have a caffeine dependence actually consumed less caffeine daily than participants who did not meet the DSM-IV-TR criteria. In some cases, as little as 100 milligrams of caffeine a day could be enough to become dependent.

People trying to avoid or cut down on caffeine face two main problems: first of all, caffeine dependence tends not to be taken all that seriously. Many medical doctors simply advise their patients to quit without providing them with any real treatment advice. That nearly 90% of the study participants had failed to stay off caffeine for long shows how difficult quitting can be. Another problem is the wide range of products with caffeine and the difficulty in avoiding it completely. Even “decaf” coffee can contain some caffeine with certain decaffeinated coffees still having as much as 20% of the original caffeine content.

While caffeine seems relatively harmless in small doses, there are still health risks involved which can pose serious problems for people with other medical or psychological conditions. Though caffeine dependence is not classified as a formal substance disorder, many of the same issues found in drug and alcohol abuse can apply as well. People wishing to cut back on their caffeine use can often need professional help although most treatment professionals do not have the experience to deal with this issue. This may change as the health risks associated with caffeine become better recognized.

In the meantime, spare a thought to how much caffeine you are taking in each day. Do you really need that extra cup of coffee?